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I attended my first funeral at the age of 15. It was for my friend and teammate who passed away in the spring of 1977 due to a self-inflicted gunshot wound. He just turned 16. This was my first experience dealing with the death of someone with whom I was close. I couldn’t get my mind around the fact he was gone. We wouldn’t be taking cheap shots at one another during football practice the next fall. We wouldn’t be shot-gunning beers stolen out of his dad’s garage fridge. We wouldn’t be grab-assing in the halls or lying to each other about all the girls from other schools. He was gone, stuck in time as a standout high school half-back and all around good dude. After 33 years, I still feel the initial shock and emotional devastation when I dwell on it too long. There were no warning signs, no telltale “I-should-have-seen-it-coming” behavior. I remember the last thing I said to him as we walked out to the parking lot after school like it was yesterday, “Let’s get shit-faced this weekend.” He yelled back over his shoulder, “Sounds good, call me.” He died that night. I wish I could say this was an isolated incident: Chalk it up to teenage angst and blame the mental health community for letting one rare case fall through the cracks. But I know better.

Death by Suicide: Exposing the Soft, White Underbelly of the West

I attended my first funeral at the age of 15. It was for my friend and teammate who passed away in the spring of 1977 due to a self-inflicted gunshot wound. He just turned 16.

This was my first experience dealing with the death of someone with whom I was close. I couldn’t get my mind around the fact he was gone. We wouldn’t be taking cheap shots at one another during football practice the next fall. We wouldn’t be shot-gunning beers stolen out of his dad’s garage fridge. We wouldn’t be grab-assing in the halls or lying to each other about all the girls from other schools.

He was gone, stuck in time as a standout high school half-back and all around good dude. After 33 years, I still feel the initial shock and emotional devastation when I dwell on it too long.

There were no warning signs, no telltale “I-should-have-seen-it-coming” behavior. I remember the last thing I said to him as we walked out to the parking lot after school like it was yesterday, “Let’s get shit-faced this weekend.” He yelled back over his shoulder, “Sounds good, call me.”

He died that night.

I wish I could say this was an isolated incident: Chalk it up to teenage angst and blame the mental health community for letting one rare case fall through the cracks. But I know better.

I attended my next funeral at the age of 22. It was for my friend and fellow musician who died the summer of 1983 due to a self-inflicted gunshot wound. He was 21.

Source: CDC website using the WISQARSTM (Web-based Injury Statistics Query and Reporting System) database

Source: CDC website using the WISQARSTM (Web-based Injury Statistics Query and Reporting System) database.

I saw my friend for the last time in Sun Valley. He had driven three hours to lend some badly needed moral support for a crappy ’80s cover band I played in and he was ready to whoop it up. We had a blast and before we went our separate ways I asked him if he needed a place to stay that night. “Naw, I’m gonna camp out somewhere,” he replied. I wish I’d gone with him. He was gone five days later. Again, I remember that conversation like it was yesterday.

I managed to get through the rest of my 20s and 30s without losing any more close friends. Oh, I went to more funerals, but they were held for relatives who’d lived full lives. Contrary to popular belief, there’s nothing terribly tragic or heartbreaking about a 72-year-old heavy smoker dying of a stroke. It’s expected; losing someone who was apparently healthy and had many years ahead is not.

I found myself standing next to another closed casket during the winter of 2005. It held my friend and fellow fisherman, who died due to a self-inflicted gunshot wound. He was 44. I always respected him as a no-bullshit, take-charge Idahoan who proved himself to be a fine outdoorsman and a good provider for his family.

Yet he left behind a wife of 20 years and a teenage daughter who were counting on him. His death took me right back to the emotional state I was in at 15. Once again, I just couldn’t get my mind around the fact he was gone and had left his wife and daughter to fend for themselves.

There is nothing more uncomfortable and unsettling than attending a funeral for a victim of suicide. The clergy tactlessly expose the white elephant in the room by referencing sin and damnation connected to the circumstances surrounding the death. Oh yes, the officiate will pray for their forgiveness, but it’s obvious mental illness is not recognized as a legitimate disease by organized religion. At least, not at the funeral.

If someone is killed in a car wreck or dies of leukemia that, too, is tragic but, apparently, all is going to be wonderful in the afterlife. Somehow, that message never comes across at the funerals of people who take their own lives, at least not the ones I have attended. During a time when family and friends are trying to make sense of what went wrong, the last thing they need to hear are judgmental eulogies based on biblical rhetoric and medical ignorance.

Thankfully, time has a way of softening the emotional blows received and, years later, I find I can look back on the deaths of my old pals with less anger and more logic. People in their right minds do not kill themselves; they are sick, just as if they had cancer or diabetes. They died because they suffered from a life-threatening disease called depression that went undiagnosed.

This map (Source: Centers for Disease Control and Prevention, National Injury Mortality Data) illustrates the age-adjusted suicide death rate across the United States. Note the brown band running from the border of Mexico north to Canada, which represents the highest rate: 14.94-23.37 per 100,000 people.

This map (Source: Centers for Disease Control and Prevention, National Injury Mortality Data) illustrates the age-adjusted suicide death rate across the United States. Note the brown band running from the border of Mexico north to Canada, which represents the highest rate: 14.94-23.37 per 100,000 people.

DOES THIS HAPPEN ALL OVER THE WEST? YES

If you grew up in the Mountain West, you probably know someone who has taken his or her own life. It’s really that common. Based on my experience, depression isn’t truly taken seriously by the indigenous population out here where the buffalo roam.

We live in a culture that requires a do-it-yourself — no pissing, no moaning — cowboy-up mentality if you want to be accepted socially. The public perception is that only the weak-minded and emotionally unstable would ever consider getting professional treatment for depression. Most Westerners don’t think of depression as a serious medical condition caused by a chemical imbalance in the brain. The fact is we largely don’t consider depression at all.

The image of John Wayne or Clint Eastwood lying on a couch, sobbing like a schoolgirl and spilling their guts to a shrink because they’re in mental anguish just doesn’t gel with the national persona of how the West should be.

If you feel down, think happy thoughts. If you’re miserable, pray about it. If all else fails, drown your sorrows around a campfire with your buddies or uncork a few bottles of Merlot with your girlfriends. This approach seems to work for the majority of folks living out here.

The problem with the cowboy approach to mental wellness is the high casualty rate it creates. The Center for Disease Control has been tracking self-inflicted death statistics for 60 years. Guess which states consistently carry the notorious distinction of having the highest suicide rates in the nation? Montana, Nevada, Idaho, Wyoming, Utah and Colorado jockey for pole position and do so every year.

By contrast, East Coast states like New Jersey, New York and Massachusetts are ranked as having the lowest suicide rates. On a side note, the 2009 CDC database shows Alaska had the nation’s highest rate, followed closely by Montana. Washington, D.C., had the lowest. All of the Mountain West states were at the top of the 2009 death rate data — as usual.

Between 1999 and 2007 there were nearly as many suicides as highway fatalities in the mountain west states. In the case of Colorado, Utah and Nevada, there were more self-inflicted deaths than traffic deaths. Am I the only person west of the Mississippi to see a problem here?

To put these data in better perspective, as of Sept. 17, 2010, there have been a total of 6,816 coalition military fatalities during our nine years supporting Operation Enduring Freedom in Afghanistan and seven years supporting Operation Iraqi Freedom (source: casualty.org). In our little six-state region, we have had roughly three times the number of deaths due to suicide than both wars combined during the same nine-year period.

I ran this search three separate times using different parameters for each search to confirm these data because I did not believe it could be correct. I assumed the WISQARSTM data base on the CDC website to be a reliable source. For now, I argue the data I have presented is accurate. I hope readers will find enough interest to do perform their own investigations. The numbers presented here show a trend nothing short of an epidemic.

WHAT CAN BE DONE?

The mental health community is aware of the problem we have in our beloved Rocky Mountains. There have been many research studies conducted in the past 30 years. The following four factors seem to be the overall conclusions as to why our suicide rates are so high, based on the half dozen studies I read in preparing this column.

From “Ranking America’s Mental Health: An Analysis of Depression Across the States” by Thomson Healthcare:

  • Mental health resources: The more mental health professionals in the state (specifically, the higher the number of psychiatrists, psychologists or social workers per capita), the lower the suicide rate.
  • Barriers to treatment: The analyses indicate that the greater the percentage of the population reporting they could not obtain healthcare because of costs, the higher the suicide rate. The portion of the population reporting unmet mental healthcare need was positively associated with suicide rates, although the connection did not quite reach conventional levels of statistical significance.
  • Mental health utilization: Holding the baseline level of depression in the state constant, the higher the number of antidepressant prescriptions per capita, the lower the state’s age-adjusted suicide rate. In addition, there was a trend showing that the higher the percentage of the population receiving mental health treatment, the lower the suicide rate.
  • Socioeconomic characteristics: The more educated the population, the lower the suicide rate. The greater the percentage of the population with health insurance, the lower the suicide rate. Median household income was negatively associated with suicide rates but, again, the connection did not quite reach conventional levels of statistical significance.The most important factor about depression and suicide in the Mountain West seems to have been overlooked in these conclusions. It’s one I mentioned earlier, essentially: We all have reputations to keep up and no self-respecting Westerner is going to bellyache about having the blues once in a while.

    No one I know is going to seek professional help for depression, regardless of how many psychiatrists, psychologists or social workers we have per capita. No one I know is going to replace a campfire and a bottle of whiskey with Prozac or Wellbutrin or Depakote. Above all, no one I know will ever bear their soul to anyone and admit they’re feeling suicidal. We grew up in the West; we just don’t do that.

    To prove my point, the Idaho legislature dropped our suicide hotline in 2007, due to budget cuts and lack of utilization. That move makes Idaho the only state in the union without a similar service. Meanwhile, Idaho was ranked No. 6 for self-inflicted death in 2007. But in our state government’s defense, no one I know would ever pick up a phone and call the hotline, especially now that we don’t have one.

    When I began writing this piece I had planned to conclude by offering links to mental healthcare sites, federal and state suicide prevention programs and suicide hotlines. But on further reflection, I realize those actions are futile, at least out here.

    We spend our time and tax dollars squabbling over issues like wolf reintroduction, grizzly habitat, public land use and Yellowstone cutthroat populations instead of saving our citizens from self-destruction. I’m not sure why, but our priorities seem to be skewed.

    As much as I dislike the cliché term “raising awareness,” I guess that’s what I’m trying to accomplish here. I don’t see a solution at the moment; I’m just sick of so many of us dying by our own hand and having the deaths swept under a rug of shame by a culture entrenched.

    Until we break down the Western stigma surrounding mental health and start treating depression as a real life-threatening disease, nothing is going to change and we can look forward to another 17,853 deaths over the next nine years.

    Clarence Worly blogs about life and other topics at Clarence Worly’s Southeast Idaho.

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Comments

  1. Sara says:

    Culture is important but it goes beyond the stigma related to mental health treatment. Alcohol and drug use are factors in many suicides. There is also a striking racial/ethnic disparity – American Indians have the highest suicide rates of any group. The reasons for that are complex…part of it is the fact that in close-knit communities, knowing someone else who commits suicide increases the likelihood of “copy-cat” acts, especially among teens.

  2. Dave Skinner says:

    I’m not sure what to say here, whether this is a good item or just liberal navel gazing. Sure we don’t have the social support systems, but that’s what family and church is for. Hmmph.

  3. Jackson says:

    The statistics presented here are pretty shocking. Thanks for the well-written article.

    Mr. Skinner, I appreciate your honesty. I would just suggest that one of the main points of the article is that families and churches are not suited to addressing mental illness. Unconditional love is important, but there is overwhelming evidence that effective treatment of mental illness demands more than love to be successful.

  4. Notsomuch says:

    Since returning to this area, I’ve been stunned by the number of suicides. The stats shown here are compelling evidence that there is clearly a problem. Kudos to you for framing the issue so elegantly.

    I don’t see suicide prevention awareness as a liberal (or conservative, for that matter) issue. The community loses precious resources with each of these tragedies. If we can reduce the number and keep families intact by illuminating the issue and addressing the underlying cause(s), I hope it makes the entire community more healthy.

  5. Liz says:

    My brother was a born-again, church going rodeo cowboy with a family til he died of suicide. Mental illness is helped by spirituality and family, but only when appropriate and needed other medical interventions are in place.

  6. Mickey Garcia says:

    Buck up Buckaroo! You could be a Haitian Cowboy without a saddle, rope or horse. Oh, and here’s some Prozac!

  7. Dan Aune says:

    Clarence couldn’t have hit it more on spot! The stigma of needing help, asking for assistance, or having a mental illness is measured with taking one’s life. Go figure – the value of a life and needing help being measured on the same scale of justice. If you are feeling the need get help…if you know someone who is vulnerable be a friend and offer help. We surely have learned this value out West.

  8. Jennifer Doscher says:

    If you say mental illness to imply that someone is feeling emotions not considered normal, ok. If you say it implying something akin to a disease, you’d be a bit off target. Many many people never quite learn how to deal with stress and trauma. Thus when something really life-altering occurs or something becomes chronic, the mind, the soul, what-have-you, grows tired. It moves towards various stages of panic and fight or flight and into hopelessness and complete exhaustion. Suicide should not be considered some “bad thing” that’s not allowed. Not everyone nearing that decision even has the genuine desire any longer to seek help or the means. Does a free hotline really do enough for the majority? Does speaking up to a friend, relative, clergyman, teacher etc. really get you help? or perhaps just their quick decision about what will fix it or some words of encouragement that fall short of true help, leaving that person still desperate. After all, if they knew what they needed to fix whatever is plaguing them, they could just do it or find it. It’s different for every individual, the reasons why, the “symptoms” and the path to healing. What may help more than anything over the long term, is if we, as a community-region, state, city, church, school, collective of concerned individuals-teach each other and especially our children how to handle trauma and stress. Maybe a “chick-flick” or a beer or a campfire helps with small-scale things, and maybe spirituality helps with larger-scale things but what if they don’t? We each have to struggle to discover what works for us, and what works once may not be the answer for the next stress or trauma. If we can teach each other how to learn, to adapt, and the likely-hood of success in so doing, perhaps those shocking statistics that startle those of us who are ultimately happier and stronger than not, will begin to decline.

  9. Dayna Whitmer says:

    Mr. Worly,

    Let me first say I am so sorry for the many tragedies you have had to deal and when the first was when you were so young and unprepared for any death, much less a suicide, it has profound and lasting effects as you describe.

    Suicide prevention requires awareness and understanding , which that pastor had no clue about. Even the pope acknowledges that life lost due to mental illness, disease and disorder is not a sin. These people were waging wars and lost a final battle.

    It is the stigma that is associated with mental health and the word suicide that prevents people from reaching out and if the person you would turn to for help condemns a mental crisis as a weakness, you would keep you mouth closed.

    Thank you for writing this article and keeping the issue in the public eye. The amount of people who are victims – victims of suicide – who did not need to die but just needed a hand to get through a difficult time and get treatment is overwhelming.

    Education and awareness are imperative !

  10. Laurie Flynn says:

    This is a compelling look at the tragedy of suicide — and its especially profound and all-too-common impact in the Mountain West states. We commend the author, Clarence Worly, for giving attention to this issue and opening a dialogue about what can be done to address it. Adding to this dialogue, we believe that routine preventive mental health screenings for adolescents — for whom suicide is the third leading cause of death — can help by identifying teens that may at risk for suicide and connecting them with behavioral health intervention. But we agree that even more can be done to overcome the stigma of mental illness and get people talking openly about it.

    – Laurie Flynn, Executive Director, TeenScreen National Center for Mental Health Checkups at Columbia University

  11. Mickey Garcia says:

    Must be something inherently more depressing about the spine of the Rockies to produce a higher suicide rate than all other regions in the U.S. I thought high wide and handsome scenery was suppose to be good for the soul and the spirit.

  12. Mickey Garcia says:

    I wonder if that same high suicide rate continues on up into the Canadian Rockies?

  13. R. Kangas says:

    Many of these unfortunante deaths are bright, artistic individuals who happen to gay and cannot find support from friends, family or institutions. I know of two families who have had to deal with suicide because of what amounts to ignorance. One was the quarterback for our football team through high school committed suicide his first year in college. Family two had three gay children. All three ended there own lives. The parents were unaccepting, unforgiving and offered no support when they discovered their children’s “lifestyle choice”… There’s more to discovering the signs of potential suicide. Let’s start by discovering situations, especially in families, that breed potential suicide.

  14. Tracy says:

    Thank you, Mr. Worly for your touching piece. I would add that the “buck up” Western culture is one that also is heavy drinking and heavily armed – not a good combination for preventing self-inflicted death. Someone close to me when I was a teenager attempted suicide by swallowing a bottle of pills, and fortunately for him and for us around him, he realized what a stupid thing he’d done and they were able to pump out his gut in time to save his life. He now has two beautiful children and a wonderful wife. There’s usually no time for second thoughts when the modus operandi is a gun. This fact makes suicide prevention in the West that much more difficult. But as someone who almost lost someone close to me to suicide, I know it’s worth the effort.

  15. John M says:

    Education,as mentioned before, allows those seeking answers, to become aware of the possible resources. Not every location has the availble resources, but with information and phone numbers linked to a real voice on the other end of the line, we can make a difference. Share a positive thought with those around you, that may be just what they needed.

  16. Jill says:

    Your article was timely, Mr. Worly. I can’t begin to tell you the number of times I look at the Great Falls (MT) Tribune obits and see where another man has killed himself.

    In the last 4 months I have seen two friends commit suicide: one had a long history of alcohol problems and used carbon monoxide to end his struggle. He was 46. Another took an overdose of pain medication as he could not keep himself from returning to drinking and drugs. He was 43. In the last year, two men from my community shot themselves – both have struggled with drinking since their teens.

    I don’t know what the answer is, but I know that it hasn’t gone unnoticed.

  17. Mehmnet says:

    I lost three people to suicide, two of them via gunshots to the head.

    I’m over it. No more tears, no more support. They want to kill themselves despite my pleas then I say “Let ‘em go ahead!”

  18. Nancy says:

    The essay is excellent, as well as the comments. But the word “guns” should be mentioned more often. As one commenter noted, heavy drinking and heavily armed is a bad combination on top of the lack of mental health resources.

  19. arrion says:

    vet experiences say you’ve never served. Suicide as something among the few in a certain geo local.? Wake up man. More vets suicide than any other group. Put first people second. Across the world and across this nation. We’ve been at non-stop deployments for decades. Your view is regional.

  20. Mickey Garcia says:

    Interesting that military and police both have high suicide rates. Both professions have a high risk of dealing with violence as a matter of course.

  21. Mehmnet says:

    And both require individuals who obviously have personalities who favor carrying guns on a legal, regular basis.

    Also – how many take out their families as well as themselves when it comes time to off themselves?

  22. Mickey Garcia says:

    It would be folly to be unarmed when you have to deal on a daily basis with opposing forces who are well armed and would just as soon see you dead.

  23. Mehmnet says:

    Well, being armed – in fact, well-armed – didn’t help those military personnel who were killed by the Ft. Hood shooter.

  24. Mickey Garcia says:

    I don’t believe that his victims were well armed at the time. In any case he had the element of surprise going for him. Not a good example.

  25. R. Kangas says:

    For a couple of years, I answered calls on a suicide hot-line. I don’t remember a call from a vet. Maybe they were ashamed to say? I do know that our goverment has played and avid role in poor mental health while creating a strong military and then, ontop of that has given some men and women a double whammie with the “don’t ask, don’t tell” policy.

    To “arrion”. “Your view is regional” …are you saying homosexuals live only in certain regions or that we are only accepted in certain regions? I have heard that the “region” known as Seattle has one of the highest suicide rate in the country. Could it be all the vets that live there? … or gays? …or gay vets? I have heard that it’s due to to a high rainfall… I’m happy to live in CO where the average days of sunshine is one of the highest in the country (322 days). But then you look at the numbers and see that MT, WY and CO are three of the top ten states with the highest suicide rate in the country and WA isn’t close.
    TO THE AUTHOR: Judging by the number of comments, you have certainly stirred the pot! Thanks for a great article!
    The coming age will survive only by compasion and empathy.

  26. Mehmnet says:

    “I don’t believe that his victims were well armed at the time. In any case he had the element of surprise going for him. Not a good example.”

    On the contrary, excellent example. “Element of surprise”: what every killer-gunman knows – that even the best well-armed citizens/soldiers/cops have their down/off-guard moments – that is when you shoot.

  27. Mehmnet says:

    I used to think unhappy homosexuals offed themselves because of their stigma in str8 society. However, as I have gone on in life, I have found that, str8 or gay, the most common cause (in my experience) of suicide has been a failed love affair. The guys – str8 or gay – have taken guns to their heads, demonstrating their determination to not only cause pain for their friends and family, but also a BIG MESS.

    After that, from what I’ve experienced, embezzlement is/was the next most common cause.

    Ultimately, you must remember: it’s a bio-chemical imbalance in the brain, brought on by who-knows-what – brain chemistry, faulty neurons, addicition-prone neurons, changes in who-knows.

    Under certain conditions, the mind sees death as a viable – indeed the *only* – alternative to severe emotional distress.

  28. Jay says:

    To top it all off:
    A large number of mental health professionals do just about anything they can to avoid treating people who are depressed.
    I suspect they also are infected by the notion of cowboying up.

  29. Mickey Garcia says:

    Focusing on the U.S. West may not tell us much. Over 1 million people world wide die by their own hand each year. Apparently an effective happy pill has yet to be invented.

  30. arrion says:

    R> Kangas
    You are incredibly naive for an adult who claims to be a suicide line operator. Vets and cops dont call a suicide line. And even others who do, often dont make it. Take off your rosy glasses.

  31. horst says:

    arrion is right, of course. Cops and vets are real men who handle their own problems.

  32. johne says:

    This topic deserves more than a cursory Googling, but here goes:

    As to whether suicide trends follow the Rockies into Canada, it appears not: of the two provinces that share the cordillera, British Columbia is slightly below the national average (11.5 suicides per 100,000 citizens), while Alberta is above it (16.3 per 100,000). (But the Yukon and Northwest Territories are at 21.1 and a whopping 31.8 per 100,000 respectively, seeming to join Alaska in a northern suicide belt) Until 1977, Canadian suicide rates were lower than those of the US, now they’re higher (13 per 100,000 vs. 12 per 100,000). American cities with the highest suicide rates included Portland, Ore., at number one. Oregon’s rate is 35% higher than the US average. Washington is 16th nationally in suicide rate, and Seattle’s rate is slightly better than average.